Another informative post by Lauren Riney, one of the excellent Pediatric Emergency Medicine Fellows at Cincinnati Children’s Hospital Medical Center.


When is ketamine ABSOLUTELY contraindicated?

  • Age younger than 3 months (primarily for risk of airway complications)
  • Schizophrenia (studies show this condition may be exacerbated with ketamine administration)

The list of relative contraindications is much longer:

  • Anything that may increase the risk of laryngospasm (major procedures stimulating the posterior pharynx, active pulmonary infection such as URI, active pulmonary disease such has asthma)
  • Anything that could be detrimental with enhanced sympathomimetic effect (porphyria, thyroid disease, HTN, heart failure, cardiovascular disease)
  • History of airway instability, tracheal surgery, tracheal stenosis
  • Increased ICP or intraocular pressure (CNS masses, hydrocephalus, glaucoma, or acute globe injury). Of note, head trauma is NOT a relative contraindication to ketamine. Newer evidence suggests that the cerebral vasodilatory effect may be cerebroprotective and the increases in pressure are minimal with normal ventilation.

The clinical practice guidelines for ED ketamine sedation, a 2011 update, is a great resource

Also, remember, dosing needs are more likely to increase with decreasing age!